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Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon

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Abstract

Background

Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital.

Methods

This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks.

Results

One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29–11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27–120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05–10.98), P = 0.04].

Conclusion

The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death.

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Acknowledgements

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Author notes

  1. Rima Moghnieh and Hani Tamim have equally contributed to the work.

  2. Amin Abyad, Marwa Jadayel, and Lyn Awad have equally contributed to the work.

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon

    Rima Moghnieh

  2. Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon

    Rima Moghnieh

  3. Department of Internal Medicine, American University of Beirut, Beirut, Lebanon

    Hani Tamim

  4. Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon

    Amin Abyad & Ahmad Ibrahim

  5. School of Pharmacy, Beirut Arab University, Beirut, Lebanon

    Marwa Jadayel

  6. Pharmacy Department, Makassed General Hospital, Beirut, Lebanon

    Lyn Awad & Dania Abdallah

  7. Infectious Disease and Residency Program, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA

    Nicholas Haddad

  8. Faculty of Medicine, Lebanese University, Beirut, Lebanon

    Jessica Berberi, Rawya Alwazir & Rida Taher

  9. Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon

    Tamima Jisr

  10. Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon

    Rawad Lakkis

  11. Division of Hematology/Oncology, Middle East Institute of Health, Bsalim, Lebanon

    Kamal Zahran

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  1. Rima Moghnieh
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Moghnieh, R., Tamim, H., Abyad, A. et al. Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon. Infection 48, 385–401 (2020). https://doi.org/10.1007/s15010-020-01407-6

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  • DOI: https://doi.org/10.1007/s15010-020-01407-6

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